Provider Demographics
NPI:1669205068
Name:LOUISVILLE MIND AND WELLNESS
Entity type:Organization
Organization Name:LOUISVILLE MIND AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-533-0446
Mailing Address - Street 1:10405 VENADO DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4510
Mailing Address - Country:US
Mailing Address - Phone:502-533-0446
Mailing Address - Fax:773-825-8297
Practice Address - Street 1:801 BARRET AVE STE 210
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1733
Practice Address - Country:US
Practice Address - Phone:502-533-0446
Practice Address - Fax:773-825-8297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty